patella open reduction internal fixation

#Patella open reduction internal fixation free

This study was a retrospective review of a prospectively collected cohort and was approved by the institutional review board (Dongsan Medical Center No. Thus, we have adopted rim-plate-augmented separate vertical wiring with supplementary fixation in the management of comminuted inferior pole fractures, AO/OTA 34-A1, C2 and C3 (Supplementary Fig. After conversion, the treatment can be almost the same as AO/OTA 43-A1 (Fig. When the fracture is classified with AO/OTA 43-C and has the secondary horizontal fracture line on the lower articular boundary of the patella, it can be converted to type A from type C by supplementary fixation, including plates or screws (Fig.

Besides AO/OTA 43-A1, there might be an expansion of the application of a novel surgical technique. These fractures should be managed with supplementary fixation.

#Patella open reduction internal fixation free

There is insufficient data on the use of Cybex isokinetic testing to analyze the functional outcome after surgical treatment.įurthermore, a free articular coronal fragment or anterior coronal split fragment associated with inferior pole fracture is frequently found in three-dimensional morphological fracture mapping study 11 (Fig. To prove effectiveness of patient’s functional recovery and safety of surgical technique, it is necessary to assess the strength of the injured limb using the Cybex test 14. Although the clinical result was favorable, the research has not evaluated functional outcomes thoroughly. modified the separate vertical wiring technique by adding a rim plate for comminuted inferior pole fracture of the patella 8. To support comminution fragments, Cho et al. Nevertheless, the surgical technique has limited capability to achieve stable fixation and can cause cutting through of wires with severe comminution in the sagittal and coronal plane of inferior pole patella fractures 8. The separate vertical wiring technique has been widely used and proven with satisfactory outcomes for these fractures 1, 2. However, there is a lack of study about surgical treatment for AO/OTA 43-C2, C3 associated comminuted inferior pole.ĭespite the variety of treatment methods, comminuted inferior pole fractures of the patella remain difficult and technically demanding to achieve stable internal fixation because the characteristics of patella inferior pole fractures are extra-articular type combined with small fragments and comminution up to 83.3% 11, 12, 13. Various surgical techniques include separate vertical wiring 1, SVW in combinations with cerclage wire 2 or augmented Krackow suturing 3, plate osteosynthesis 4, suture button fixation 5, partial patellectomy followed by patella tendon reconstruction using trans-osseous suture or anchors, among others 6, 7, 8, 9, 10. Several treatment options for patella inferior pole fracture have been reported in the literature. The surgical goal of repairing patella fracture is to restore the extensor mechanism while simultaneously achieving articular congruency. The rim plate-augmented separate vertical wiring with supplementary fixation for the treatment of patellar fracture associated comminuted inferior pole is effective and can be safely applied AO/OTA 34-C2 or C3 with favorable outcomes. Isokinetic peak torque deficit of the knee extensor muscles in 3, 6, 9, and 12 months postoperatively was 59.9%, 49.7%, 35.7%, and 28.1%, respectively. Lysholm knee scores gradually increased over 3, 6, 9, and 12 months postoperatively by 58.7, 74.0, 82.9, and 89.4, respectively. The average final range of motion was 131.6° ± 7.2°.

There was no patient with loss of reduction, fixation failure, or infection during follow-up.

From our study, bony union was achieved in all patients at an average of 3.1 ± 1.4 months after surgery. The purpose of this study is to evaluate the clinical outcomes of rim plate-augmented separate vertical wiring with supplementary fixation in the management of comminuted inferior pole fractures, AO/OTA 34-A1, C2, and C3, which has the secondary horizontal fracture line on lower articular boundary. Despite the variety of treatment methods, comminuted inferior pole fractures of the patella remain difficult and technically demanding to achieve stable internal fixation.